Watertown Family Practice Associates, S.C. Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Protecting Your Privacy
It is your right as a patient to be informed of the privacy practices of your health care provider as well as to be informed of your privacy rights with respect to your personal health information. This Notice of Privacy Practices is intended to provide you with this information. We are required by law to:
Watertown Family Practice Associates, S.C. (WFP) reserves the right to change the terms of the notice of privacy practices and make the new notice provisions effective for all protected health information that it maintains. WFP also reserves the right to change the terms of its notice with respect to any applicable more limited uses and disclosures.
WFP will promptly revise and make available its notice whenever a substantial change is made to any of its privacy practices and post the new notice on our web site at www.watertownfamilypractice.com. WFP will not use or disclose your health information without your authorization, except as described in this notice.
Your Health Information Rights
You have the right to:
Uses and Disclosures for Treatment, Payment and Health Care Operations
WFP is permitted by the federal privacy rule to use or disclose your protected health information for treatment, payment or health care operations. WFP may not disclose HIV test results, psychotherapy notes, alcohol or other drug abuse treatment records without your written authorization, unless required by law.
Watertown Family Practice Associates, S.C. may use or disclose your health information for treatment.
WFP may use or disclose your health information in the provision, coordination or management of your health care.
Example: Your information may be disclosed from one physician to another if they are consulting each other in relation to your care and treatment.
Example: WFP may use your health information to provide you with an appointment reminder.
Example: WFP may send you information about treatment alternatives or other health related services that may be of interest to you.
Watertown Family Practice Associates, S.C. may use or disclose your health information for payment.
WFP may use or disclose your health information to obtain reimbursement for the provision of health care services. The bill may include information that identifies you, your diagnosis and your treatment.
Example: WFP may use or disclose your information to your insurer to obtain payment for the provision of health care services.
Watertown Family Practices Associates, S.C. may use or disclose your health information for routine heath care operations.
WFP may use or disclose your health information for evaluation of patient care services, evaluating the performance of health care providers, activities relating to compliance with the law and business planning and development.
Example: WFP may review your health record to determine the efficiency of the services provided to you in the emergency room.
Uses or Disclosures of Your Protected Health Information Permitted Without Your Authorization
WFP may use or disclose your health information for the following purposes when required by law:
Other uses of medical information:
In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. These situations include certain uses and disclosures of your medical information for marketing purposes and disclosures that involve the sale of medical information. You may opt out of receiving fundraising materials from WFP. If you choose to authorize use or disclosure of your medical information, you can later revoke that authorization by notifying us in writing of your decision. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect.
If you believe your privacy rights have been violated, you may file a complaint with WFP or with the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint. To file a complaint with WFP please contact the clinic’s Privacy Officer who will provide you with the necessary assistance.
All sales are final.
Questions or Concerns
If you have questions or concerns regarding your privacy rights or the information in this notice, please contact:
Watertown Family Practice Associates, S.C.
127 Hospital Drive
Watertown, WI 53098
This Notice of Privacy Practices is Effective as of April 14, 2003
Revised September 23, 2013